Johannesburg: Wednesday, 14 October 2009 South African medical history was made this week when the first Transcatheter Aortic Valvular Implantation (TAVI) procedures in South Africa were completed at Netcare Sunninghill Hospital. In the next few days a total of eleven TAVI procedures will be done in Johannesburg, Durban and Cape Town as part of a training programme led by world renowned cardiologists and surgeons. The procedures have been given the full backing of the South African Society of Cardiovascular Intervention (SASCI) - a working group of the South African Heart Association.

For those who have severe aortic heart valve stenosis (narrowing) and who will not be able to survive open-heart surgery, there has been little to do except wait to die. The groundbreaking heart procedures were successfully completed on three such patients at the Netcare Sunninghill Hospital in Johannesburg over the course of Monday and yesterday, and they are all doing well according to hospital authorities.

The three operations were the first of their kind in Africa, and give new hope to those who do not qualify for open-chest heart surgery, according to Johannesburg team leader Dr Farrel Hellig, a Cardiologist from the Netcare Sunninghill Hospital who is also the Vice President of SASCI.

He explains that there are several reasons why a patient may not be suitable for open-heart surgery. Patients may have co-morbid conditions (other medical conditions occurring together with the diseased valve) that preclude open-heart surgery. Patients may be in such a frail condition as to not be able to survive the anaesthetic necessary for the surgery, or the open-heart procedure itself.

The TAVI procedure is a breakthrough in South African medical science, says Dr Hellig. The procedure, which involves doctors using tubes known as catheters to implant a device to replace a diseased heart valve, can considerably improve the quality of life of patients as well as give them many more years of life. The device used, which is known as the Transcatheter Aortic Heart Valve, and manufactured by international medical equipment manufacturer Edward Lifesciences, is ?a little miracle?, according to Dr Hellig.

?The Transcatheter Heart Valve procedure is far less invasive than traditional open-heart surgery,? continues Dr Hellig. ?In other words, the new approach makes it possible to repair the heart valve without having to resort to traumatic chest opening surgery. Seriously ill patients are therefore more likely to survive the procedure. Patients also often recover relatively quickly; some are up and about within days.?

According to Jacques du Plessis, Managing Director of Netcare?s Hospital division: ?As patient recovery times tend to be quicker with improved outcomes, the TAVI can result in some savings. For example, patients are in hospital for a shorter duration than they are likely to be after open-heart surgery.?

?The four elderly Johannesburg patients, two of whom are male and two females, suffered severe aortic disease and were ?very ill?, says Du Plessis. Apart from Dr Hellig, the team included renowned cardiologist and President of SASCI, Dr Graham Cassel of Netcare Milpark Hospital, and cardio-thoracic surgeons Dr Jan Coetzee of Netcare Sunninghill and Dr Martin Sussman of Netcare Milpark Hospital. Echo cardiologist, Dr. Eric Klug was responsible for the ultrasound imagining.? Du Plessis reports that the operations were a resounding success and that the patients are recovering well.

The procedures are the first in a series of countrywide cardiac interventions that are being performed in Johannesburg, Durban and Cape Town. A total of eight of the procedures will be undertaken in Netcare Hospitals. The team at Netcare St Augustines Hospital is lead by interventional cardiologist Dr Jai Patel supported by interventional cardiologist Dr Mohamed Hassim, cardio-thoracic surgeons Dr David Shama and Dr Myenderan Odayan, and echo cardiographer, Mr Reventheran Pillay.

Dr Cassel says that the project, which aims to introduce TAVI to South Africa, and help train medical teams in the procedure, has been ?a first in so many ways?. It has been a model of medical collaboration. SA?s top cardiologists and cardio-thoracic surgeons in three South African cities are working together on the same medical teams. Two different private hospital groups are participating in the project. In addition two UK experts, Mr Vinayak Bapat, consultant cardio-thoracic surgeon at Guy?s and St Thomas? Hospitals in London and Dr Martyn Thomas, clinical director for cardiothoracics and consultant cardiologist at St Thomas? Hospital in London are in South Africa as proctors for the procedures.

He adds that this has been a once in a lifetime experience with South African teams learning so much from their British colleagues. For twelve seriously ill South African patients this will be a lifeline that will change their lives forever.

TAVI could not have been brought to South Africa without the collaborative efforts of the hospital groups; the medical teams involved and the manufacturer of the Transcatheter Heart Valve, Edward Lifesciences. The medical teams at the three hospitals are undertaking the procedures free-of-charge as part of their training, according to Dr Cassel.

The three medical teams all had to undergo training with Edward Lifesciences in Switzerland before the project could commence, explains Dr Cassel. Three eight person teams were formed each consisting of two cardio-thoracic surgeons, two interventional cardiologists, one anaesthetist as well as an echocardiographer, a catheter lab technician and a catheter lab scrub sister. They had to undertake simulator training and observe several live cases.

Malcolm Anthony, Managing Director of Edward Lifesciences says that, due to the significance of these procedures to South African medicine, the company has reduced the costs of the valves for the twelve teaching procedures substantially. He goes on to explain that the transcatheter heart valve is inserted rather like a stent and acts to replace a severely diseased heart valve. The valve is put in place via catheter and a ?balloon? is used to blow the artificial valve up to the correct size. Once the new valve is in place the balloon is removed.

He says there are two different approaches to the heart valve therapy. The transfemoral delivery system involves pushing the compressed replacement valve up through the femoral artery in the groin via a catheter. Where arteries are too diseased or where there may be kinks or other obstructions, the transapical delivery system is used. This involves the replacement valve being delivered directly in through an opening near the ribs through the apex (tip) of the heart. Half of the patients being operated on this week require the transfemoral approach while the other half require the transapical.

The TAVI intervention is offered to patients in Europe where some 3 000 operations have already been completed. The procedure has a low operative mortality and good long-term results. It is however still undergoing an FDA review process in the United States where it is not as yet available.

?This is a medical breakthrough in South Africa that we really hope will become more-and-more widely used here,? concludes Dr Cassel. ?It is also a lifesaving procedure that brings hope to those who were previously in the unenviable position of having no treatment options available to them whatsoever.?